Provider First Line Business Practice Location Address:
2631 CROSBY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KLAMATH FALLS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97603-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-880-2750
Provider Business Practice Location Address Fax Number:
541-880-2759
Provider Enumeration Date:
11/13/2006